'First do no harm' is an incredibly powerful and important statement, most commonly associated with doctors of medicine, but also many other health professionals that work with patients or clients.
It's certainly a saying that is central to my practice, which I am proud to say is 100% ethical. I have spent years emphasising and re-emhasising this to my students that our actions must be in the best interest of the public or our client. It is why I don't advocate fad diets or quick fixes. It's why I explore all our other health behaviours in addition to eating when it comes to improving health. It's why I work really hard at helping my clients understand their own body. But there's a BIG but!
I have had the benefits of weight loss drilled into me for over 20 years. That a higher BMI (body mass index commonly used as a measure of fatness and health) is associated with an increased risk of disease and death. Basically I have been told the evidence shows increased fatness leads to disease and that dieting will improve health. Well I've just had my mind blown on a recent kindful eating course, teaching Well Now. It's changed the way I think.
What if I told you that weight is not the biggest determinant of health, that weight loss is not the be all and end all for fatter people?
What if I told you that weight loss is so rarely successful in the long term, that weight loss ultimately leads to a higher BMI (weight gain) and worse health?
Did you know that calorie restriction is more likely to result in weight fluctuation (yo yo dieting) and this increases your risk of heart disease? It also messes with your head and metabolism.
Did you know our body will put mechanisms into place to prevent weight loss? This is why it can be so hard!
What if I told you that gold standard evidence concludes trying to lose weight "is likely to do more harm than good" and "cannot be recommended as a safe and effective treatment"? And that’s quite aside from how the ‘get thin’ message leads to prejudice and shame, neither of which improves personal or population health.
You might be thinking this is nothing new and to be honest, maybe it's not. Perhaps you had an inkling that dieting was not the answer. Maybe from personal experience you realised it doesn't work for you.
I feel I've been taken for a ride; taken down the wrong path by my teachers and leading researchers. I honestly think I've been brain washed that all overweight people should lose weight. Lets face it we read about obesity every single week. Come to think of it, is ‘overweight’ ever a useful term? Or ‘obesity? We are constantly reminded of this global crisis; the pressure to lose weight to reduce our disease risk is drummed into us from every single angle. We must be thinner. We must be thin. The pressure to conform. This really angers me!
My sciency brain says 'read the literature', what does the research say? My professional code of conduct tells me I can't rely on anecdotes. I can't act on hearsay. I KNOW PEOPLE who have given up on dieting because it was driving them nuts, literally. My gut has been niggling that something didn't feel right about pushing weight loss but I couldn't put my finger on it. My practice MUST have an evidence base. It must be based on GOOD QUALITY research!
I am also aware that you see what you want to see. Expectation is a powerful force. If you want data to show you that weight loss works, more than likely that's what you'll see. The conclusions get over simplified and no one questions them. It's like Chinese whispers. I can't actually think of a health or clinical guideline that doesn't say lose weight to combat obesity and reduce the impact of disease. Eating better and exercising more may not work. It's a hell of a lot more complicated than this!
It was only pointed out to me earlier this year that our government and medical recommendations are based on old and very weak science. Studies on weight loss involving incredibly small numbers of people over very short time periods. These are severe limitations in study design. We simple can't take the findings seriously; we can't apply them to real life because they don't look at the bigger picture.
I'm not saying a good diet doesn't matter, of course it does. A good diet can stop you getting constipated, protect against heart disease and Type 2 diabetes. But we must also consider that illness, poverty, inequalities, mental health and stigma are equally if not more powerful indicators of health than body weight. These factors can significantly alter our metabolism. I have genuinely had a light bulb moment and realised that weight loss is not the right answer. There is no evidence to suggest that weight loss even works in the long term.
And then there's the question of what is health anyway? A number on the weighing scales? A blood pressure or blood glucose measurement? Simply the absence of disease? Is that all we are? What about our feelings, emotions, stresses, who each of us really is? So many emotions we experience get played out in food. We are so much more than Calorie burning machines.
So many of us are obsessed with getting thinner; we would do anything to win the race, but at what cost? Relentless searching for the 'perfect' diet and exercise programme. The 'need' for surgical help or correction. All this whilst losing sight of our desire to improve our health and well being along the way. The emotional battles, degradation and negative self talk that goes on as we strive for 'perfection'. Popular diets so often lead us to feel deprived and worthless when we can't match unattainable body standards. Its these issues that lead us to losing our relationship with food, over eating and body disconnect. It's the dieting that worsens our health.
I got into nutrition to make a positive difference. But if I'm asked by my clients whose primary goal is to lose weight in the long term, I can't guarantee I can do this. What if it's not the healthiest option? Weight loss may certainly be a secondary effect of the work we do on cravings, appetite control, emotional and erratic eating for example but it can't be the be all and end all. Yes, I'll help you with your style of eating. If you want to lose weight to have more energy, help ease joint pain or to feel more confident, we can explore that too. We'll definitely work on self compassion. To prescribe Calorie restriction just to lose 15 pounds I think would be unethical. If this means taking a non-conventional approach to improving your health, then I'd rather take that road to helping you feel happier with yourself, no matter how long it takes. I want to promote more positive relationships with food, without demonising it, focus on developing self compassion so we can live without guilt and shame. Your health behaviours are what determine your health. Working to improve these alone will lead to better health in the long term :-)
Thoughts on a postcard please!!!